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Paucis Verbis card: Pertussis

Pertussis Organism

Is your Emergency Department administering Tdap immunization boosters instead of dT boosters? Patients with wounds are getting updated not only for tetanus and diphtheria, but also now for pertussis.

Apparently there has been sharp rise in the national incidence of pertussis (Bordetella pertussis shown in image) in 2010. The infection has been documented in both infants (underimmunized less than 3 months old) and adolescents/adults (loss of immunity after 10 years). In fact, the CDC has issued an epidemic warning in California.

How do you diagnose pertussis ? What are the classic symptoms? Better yet, how do you rule-it out clinically?

You won’t like the answer. It often presents like the common cold and clinical symptoms are minimally helpful in making the diagnosis. So, according to the American Academy of Pediatrics, you should treat anyone under the age of 3 months in whom you suspect pertussis. Complications from pertussis in infants include apnea, seizures, secondary pneumonia, and death. That means any with an innocent cough should be treated with azithromycin!

The following is a meta-analysis article from JAMA on diagnosing pertussis in adolescents and adults.

PV Card: Pertussis


Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

  1. Cornia P, Hersh A, Lipsky B, Newman T, Gonzales R. Does this coughing adolescent or adult patient have pertussis? JAMA. 2010;304(8):890-896. [PubMed]
By |2021-10-18T10:07:39-07:00Sep 3, 2010|ALiEM Cards, Infectious Disease, Pulmonary|
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Paucis Verbis card: Croup

The most common cause of stridor in pediatric patients is croup, or laryngotracheobronchitis. The distinct high-pitched, seal-like,”barky” cough can be heard from outside the patient’s room often.

Check out the YouTube clip above. Go to the 1:15 mark (near the end) to hear the barking cough. Poor but cute kid.

What is the current treatment regimen? Did you know that the traditional treatment with cool mist or humidified air have shown to be of no added benefit?

PV Card: Croup


Go to ALiEM (PV) Cards for more resources.

By |2021-10-19T19:29:51-07:00Aug 20, 2010|ALiEM Cards, ENT, Infectious Disease, Pediatrics|
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Paucis Verbis card: Septic Arthritis

Knee PainIn the workup of monoarticular arthritis, the question that emergency physicians constantly struggle over is whether the patient has a nongonococcal septic arthritis. This joint infection alarmingly damages and erodes cartilage within only a few days.

This installment of the Paucis Verbis (In a Few Words) e-card series reviews the JAMA Rational Clinical Examination article which asks “Does this patient have septic arthritis?” Pooled sensitivities and likelihood ratios were calculated. These statistics are always helpful when trying to figure out the patients probability of having a septic joint.

I was surprised to learn that only about 50% of patients with septic joints have a fever. Note that a hip or knee prosthesis PLUS an overlying skin infection pretty much equals a septic joint (LR = 15.0).

Risk factors are listed in the table with the corresponding sensitivities, specificities, and likelihood ratios.

PV Card: Septic Arthritis


Go to ALiEM (PV) Cards for more resources.

By |2021-10-19T19:42:49-07:00Jun 11, 2010|ALiEM Cards, Infectious Disease, Orthopedic|
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Paucis Verbis card: Early goal directed therapy

One of the landmark studies in sepsis was conducted by Dr. Emanuel Rivers (Henry Ford) and published in the New England Journal of Medicine in 2001. By managing patients with severe sepsis and septic shock with an “early goal directed therapy” approach, there was an absolute risk reduction of 16%. Furthermore, the number needed to treat to save a life was 6 patients!

This installment of the Paucis Verbis (In a Few Words) e-card series reviews Early Goal Directed Therapy algorithm. The layout is borrowed from a Cleveland Clinic Foundation (CCF) flowchart.


Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

  1. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368-1377. [PubMed]
By |2021-10-19T18:50:19-07:00Apr 16, 2010|ALiEM Cards, Infectious Disease|
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Paucis Verbis Card: CNS Infections

PV Card: CNS Infections

Here is another installment of the Paucis Verbis (In a Few Words) e-card series on the topic of CNS infections from EM Clinics of North America 2009.

 


Adapted from [1]
Go to ALiEM (PV) Cards for more resources.

Reference

  1. Somand D, Meurer W. Central nervous system infections. Emerg Med Clin North Am. 2009;27(1):89-100, ix. [PubMed]
By |2021-10-19T19:19:54-07:00Dec 29, 2009|ALiEM Cards, Infectious Disease, Neurology|
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